Training Clinicians in Private Practice in Family-Based Treatment for Anorexia Nervosa: Randomized Controlled Trial Comparing Two Online Approaches

Background: There is a critical need to disseminate efficacious psychosocial treatments for mental disorders because there is a significant gap between evidence-based treatment (EBT) approaches and usual clinical practice. To address this gap, cost-effective, efficient, and scalable methods of training mental health clinicians in EBT are needed. One example of the need to improve dissemination and implementation of psychosocial treatments is for adolescents with anorexia nervosa (AN), a serious mental disorder with an incidence rate of about 1% that can become life-threatening. Based on outcomes from a series of randomized controlled trials (RCTs), an EBT for adolescents with AN is family-based treatment (FBT); however, few therapists are trained in the approach. Some studies suggest that online training is feasible for training clinicians treating eating disorders, including pilot data related to FBT specifically, but RCTs examining different training formats for FBT to improve fidelity and patient outcomes are needed. Objective: This study compared 2 different formats for delivering online training in FBT to therapists treating adolescents with AN and planned to assess the feasibility of the 2 training formats, as well as to examine whether either approach was superior in improving fidelity to FBT or patient outcomes. Methods: Participants were 123 mental health therapists licensed in the United States in private practice with no previous FBT training. Therapists were randomized to either (1) a webinar training lecture series or (2) an interactive e-training on-demand program (ET-FBT) with an additional focus on key FBT interventions. Both groups were offered up to 12 one-hour group-based clinical case consultation (CCC) sessions posttraining. We examined the feasibility and acceptability of the online training programs and posttraining outcomes in fidelity to key components of FBT, self-efficacy, and working alliance. We explored rates of patient early response (weight gain of 2.4 kg at session 4) in adolescent patients with AN treated after FBT training during CCC. Results: Both online trainings had a high completion rate of 95% (117/123), with CCC completion at 38% (47/123). Both programs showed significant improvements within randomized groups in therapists’ fidelity, self-efficacy, and working alliance. Working alliance improved significantly more in the ET-FBT group, but there were no other significant differences between training groups. Early response rates doubled posttraining and CCC (16%-34%), regardless of randomized training format, a rate that is similar to that achieved by therapists in RCTs examining FBT treatment outcomes. Conclusions: It is feasible to deliver online training in FBT to clinicians in private practice in 2 different formats, and both trainings led to significant improvements in fidelity, self-efficacy, working alliance, and patient outcomes. Future studies should address challenges in patient recruitment for posttraining CCC and refine CCC implementation to maximize training effects and efficiency. Trial Registration: ClinicalTrials.gov NCT04428580; https://clinicaltrials.gov/study/NCT04428580 International Registered Report Identifier (IRRID): RR2-doi: 10.1016/j.cct.2022.106889